Description
Investigate, evaluate, and settle insurance claims within assigned authority, ensuring coverage, liability, and damages are accurately determined and payments comply with policy terms, laws, and company procedures. Coordinate with legal counsel on litigated files and deliver timely, customer-focused resolutions.
- • Refer suspected fraud, subrogation opportunities, or other special issues to SIU, subrogation, or legal teams.
- • Gather and preserve evidence to support coverage positions or litigation.
- • Confer with defense counsel on litigated or potentially litigated claims and implement litigation plans.
- • Contact claimants, physicians, and employers to obtain medical updates, work status, and wage information.
- • Maintain organized claim files and manage a diary to ensure timely follow-up and compliance.
- • Present files and participate in roundtables or claim committee meetings to obtain direction on strategy and settlement.
- • Conduct detailed bill and estimate reviews to control expenses and ensure accuracy.
- • Identify and report overpayments, underpayments, and other irregularities; pursue recovery when appropriate.
- • Prepare status reports and recommendations for management and other stakeholders.
- • Attend mediations, depositions, or trials as required.
- • Negotiate settlements or recommend litigation when settlement is not feasible.
- • Communicate regularly with insureds, claimants, agents, and vendors to provide updates and manage expectations.
- • Pursue subrogation or salvage opportunities and coordinate recovery efforts.
- • Review claim notices, policy terms, and coverage to confirm applicability.
- • Analyze information gathered during investigations and document findings and recommendations.
- • Review police reports, medical records, bills, and property damage estimates to assess liability and damages.
- • Inspect or coordinate inspections of damaged property and evaluate repair or replacement costs.
- • Interview claimants, witnesses, agents, employers, and medical providers to clarify facts and resolve discrepancies.
- • Investigate, evaluate, and settle claims promptly and fairly to achieve quality outcomes and control loss costs.
- • Establish, monitor, and adjust reserves in line with company guidelines.
- • Handle complex or high-exposure claims within authority or escalate as appropriate.
- • Issue payments and process transactions within designated authority levels.
- • Review independent adjuster, appraiser, or expert reports and obtain additional investigation when needed.
- • Verify and analyze data supporting coverage, liability, and damages to ensure claim validity and proper settlement.
- • Document claim activity thoroughly and accurately in the claim system, including payments, reserves, and correspondence.
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This site includes information from O*NET by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license. Career Clutch has modified some of this information for student readability. USDOL/ETA has not approved, endorsed, or tested these modifications. O*NET® is a trademark of USDOL/ETA.
Last reviewed: Jan 2026
